Efficacy of Nucleot(s)ide Analogs Therapy in Patients with Unresectable HBV-Related Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Aim. To determine whether nucleot(s)ide analogs therapy has survival benefit for patients with HBV-related HCC after unresectable treatment. Method. A systematic search was conducted through seven electronic databases including PubMed, OVID, EMBASE, Cochrane Databases, Elsevier, Wiley Online Library, and BMJ Best Practice. All studies comparing NA combined with unresectable treatment versus unresectable treatment alone were considered for inclusion. The primary outcome was the overall survival (OS) after unresectable treatment for patients with HBV-related HCC. The secondary outcome was the progression-free survival (PFS). Results were expressed as hazard ratio (HR) for survival with 95% confidence intervals. Results. We included six studies with 994 patients: 409 patients in nucleot(s)ide analogs therapy group and 585 patients without antiviral therapy in control group. There were significant improvements for the overall survival (HR = 0.57; 95% CI = 0.47–0.70; p < 0.001) and progression-free survival (HR = 0.84; 95% CI = 0.71–0.99; p = 0.034) in the NA-treated group compared with the control group. Funnel plot showed that there was no significant publication bias in these studies. When it comes to antiviral drugs and operation method, it also showed benefit in NA-treated group. At the same time, overall mortality as well as mortality secondary to liver failure in NA-treated group was obviously lesser. Sensitivity analyses confirmed the robustness of the results. Conclusions. Nucleot(s)ide analogs therapy after unresectable treatment has potential beneficial effects in terms of overall survival and progression-free survival. NA therapy should be considered in clinical practice.

Single center analysis of therapy and outcomes of hepatocellular carcinoma in Sub-Saharan Africa

“…Active HBV DNA replication and integration in hepatocytes induces genetic damage, predating the formation of abnormal cells and development of HCC [19]. It is therefore not inconceivable that suppression of viral replication will be beneficial to the survival of patients with HBVrelated HCC, and this has been echoed in multiple studies [20][21][22]. Though these findings have been clearly described in resource-rich settings, the information from HBV-endemic areas with low resources is not readily available.…”

2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations

“…244 Another meta-analysis found significant improvements for the OS and PFS in the NA-treated group compared with the control group for patients with HBV-related HCC after unresectable treatment. 245 Antiviral agents with high genetic barrier to resistance (entecavir and TDF) should be used as adjuvant therapy because only they reduced the risk of HCC recurrence compared with other antivirals, especially in patients with high baseline viral load. 246 HBsAg negative, anti-HBcAb positive patients are at risk of HBV reactivation post TACE.…”

Current Therapy of Chronic Viral Hepatitis B, C and D

“…Here, treatment should be initiated in all individuals that tested positive for HBV DNA via PCR regardless of transaminase levels or viral load [ 12 , 13 , 14 ]. This is also true for patients with HBV-related HCC and positive HBV PCR, as the risk of tumor recurrence or progress can be reduced [ 15 , 16 , 17 ]. Further therapy indications include a reduction in maternal transmission in pregnancy, professional (e.g., medical staff) or social reasons to reduce the risk of transmission, extrahepatic manifestations of HBV infection, and the prevention of HBV reactivation via immunosuppression.…”